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System Profile: San Diego Medical Services Enterprise

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San Diego has successfully used smart powerful devices and software in EMS for a decade, and soon that success will be available for users everywhere.

San Diego’s EMS is responsible for the 9-1-1 medical care of 1.3 million citizens. This service is provided by San Diego Medical Services Enterprise (SDMSE), a highly successful public-private partnership between the San Diego Fire-Rescue Department (SDFD) and Rural/Metro Corporation.

Until 1999, we recorded all patient information on paper Scantron "bubble" forms, which often were lost, incomplete or illegible. The missing information added up to millions of dollars of uncollected billing revenue and hundreds of work hours tracking down frustrated personnel for lost paperwork. We needed a more accurate, efficient and dependable method of collecting and transmitting patient information between EMS, hospitals and the billing office. TapChart was developed to meet these needs.

One of the most unique aspects of the system is that it was developed by one of the department’s own: San Diego Fire-Rescue Department (SDFD) firefighter/paramedic Greg George saw the need and designed and programmed the software now used throughout the city and other EMS agencies in the county.

With more than 70,000 records created annually, TapChart has made San Diego safer for its residents and visitors. It prompts emergency responders to ask detailed follow-up questions that might otherwise be overlooked and has a built-in database of medications for field reference. Also, the city has annually gained thousands of extra hours of paramedic ambulance availability that were previously lost on time-consuming paperwork. Having more ambulances available for responses means faster response times, which means potentially better outcomes for patients.

A key feature of TapChart is the ability to create a continuous record of patient information. Instead of passing along handwritten notes, firefighters now wirelessly transfer patient assessment and treatment information to ambulance paramedics, who in turn provide a legible copy to the hospital emergency department (ED). This report is significantly more detailed and useful to ED physicians.

As with any new technology, there was a learning curve to TapChart. We found that the majority of field personnel were comfortable using it within hours of training. However, the most vocal critics of TapChart during the initial deployment are now its strongest advocates. Also, newly recruited paramedics have reported that such high-tech tools as TapChart influenced their decision to seek employment with SDMSE.

For years, SDMSE has wanted to share the local success of TapChart with other EMS systems. SDMSE recently partnered with ImageTrend to redevelop and deliver TapChart to the EMS marketplace.

"Introducing technology into a job that has life-or-death risk. If it’s not done right, is a recipe for disaster," says Roger Fisher, SDFD administrative manager and the original flight paramedic who a decade ago wondered if these new PDA devices could have an application in EMS. "You don’t wave your hand and say ‘Here’s this tool—use it.’ A lot of vendors come in and say this. Just because you have neat gadgets and toys doesn’t necessarily mean they have a place in public safety. TapChart was designed to be used as a tool to put in public safety’s hands that leads to better documentation and better patient care."

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